FAMILIENTREFFEN DAUTERMANN 2010

REGISTRATION FORM

NAME:______________________________________________________________

ADDRESS:___________________________________________________________

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              City                                     State                         Country              Zip

Telephone:  __________________________________________________________

                        Home                                Work                        Cell

E-Mail_______________________________________________________________

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Reunion Registration Fees:

Adult:  $175.00, Youth: (4–11 yrs) $160.00,  Ages 0-3 yrs:  free

Total Number of People Attending:_________Adults:_________Youth:___________

                                                                                                      Ages:___________

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Tee-shirt Sizes and Quantity:

Adult sizes:

S________M________L_________XL________XXL________XXXL__________

Youth sizes:

S________M________L_________XL________

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Payment needed by June 1, 2010

Make checks payable to:  Gail Glover

Mail to:  4008 Emerald Drive

  St. Charles, MO  63304

Phone:  636-447-9456

E-mail:  g.glover@sbcglobal.net

Website:  www.dautermann.com

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Special Requirements: (i.e., dietary needs, disability needs, etc.)________________________

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Please list suggestions, ideas, welcome bag donations, drawing donations or other pertinent

information below:____________________________________________________________

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PLEASE USE REVERSE SIDE

OR ADDITIONAL PAGES IF NECESSARY

Deadline to register is JUNE 1, 2010